Developmental Issues: Speech, Language, and Learning Disabilities

Developmental disabilities are a group of disorders caused by impairments in physical, learning, language, or behavioral areas. These disorders begin during the developmental period; they often impact activities of daily living, and they usually last a lifetime.

Sometimes intellectual and developmental disabilities occur together. A child diagnosed with intellectual and developmental disabilities may have a low IQ, as well as limited communication and social skills, and be unable to take care of him or herself. As the child develops, he or she may learn at a slower rate than other children, and have a limited ability to learn new things. Some indications of intellectual and developmental disabilities include learning to walk or crawl later than most children, speech problems, difficulty remembering things, and difficulty with logic or problem solving. Global developmental delay is the term applied to a child under five years of age who fails to meet expected developmental milestones and has significant impairments in multiple areas of intellectual functioning.

Developmental disabilities typically originate from an event around the time of birth, but the results may not be noticeable until years later. Children who have intellectual and developmental disabilities may have experienced a traumatic head injury during labor and delivery, or may have been deprived of oxygen during or near the time of birth. Listed below are some common birth injuries that can cause intellectual and developmental disabilities:

• Hypoxic-ischemic encephalopathy (HIE)/birth asphyxia. HIE is caused by a lack of oxygen or blood in the baby’s brain around the time of birth. It usually involves damage to the basal ganglia, cerebral cortex, or watershed regions of the brain, but it sometimes includes periventricular leukomalacia (PVL). PVL is injury to the brain’s white matter.
• Brain bleeds (extracranial and intracranial hemorrhages) such as a subdural hemorrhage, subgaleal hemorrhage, and intraventricular hemorrhage (IVH)
• Infection, such as sepsis, and/or meningitis, encephalitis, or pneumonia
• Stroke
• Prolonged and mismanaged jaundice/kernicterus
• Neonatal hypoglycemia

Speech delays and language disorders are common childhood developmental disabilities. Speech is the sound that comes out of a child’s mouth. Language has to do with meaning rather than sounds. Language is a measure of cognitive function; language disorders are generally a more serious problem than speech disorders.

Language disorders refer to problems with:

• A child’s ability to get meaning or messages across to others (expressive language disorder), or
• A child’s ability to understand the message coming from someone else (receptive language disorder).

A child can have an expressive language disorder or a mixed receptive-expressive language disorder. A child with a language disorder is able to produce sound and speak in a way that is comprehensible to others.

Most children naturally develop language, starting at birth. Being able to understand and remember is crucial for language development. Spoken language also necessitates the physical ability to form sounds. Problems with receptive language skills usually begin before a child is four. Language disorders often occur in children with other developmental problems, autism spectrum disorder, hearing loss, and learning disabilities. All of these conditions are frequently caused by damage to the brain.

Children with language disorders typically have one or two (sometimes more) of the symptoms listed below:

Children with a receptive language disorder may have:

• A difficult time understanding what other people say
• Problems following spoken directions
• Difficulty organizing their thoughts

Children with an expressive language disorder have problems using language to express what they need or what they are thinking. These children may:

• Have a difficult time putting words together to create a sentence. Alternatively, their sentences may be simple and short, and the words may not be in order
• Have a hard time finding the right words when talking, and often use placeholder words such as “um”
• Have a vocabulary that is below the level of other children that are the same age
• Repeat certain phrases over and over again, and repeat (echo) parts or all of questions
• Have improper use of tenses (past, present, future)
• Leave words out of sentences when talking

Early intervention is very important when a child has a speech or language problem. Speech and language therapy programs are the best approach, and children may also need psychological therapy, including psychotherapy, counseling, cognitive therapy, and/or behavioral therapy due to the possibility of related emotional or behavioral problems.

If parents suspect a speech or language disability in their child, they should take their child to the pediatrician. Some pediatricians will refer the child to a speech/language pathologist right away, while others have a “wait and see” approach. An immediate referral for evaluation is always appropriate if parents suspects a speech or language disorder; research shows that most developmental disabilities are first recognized by parents. Furthermore, the sooner a language or speech disorder is diagnosed, the sooner treatment can begin. Early treatment may prevent the frustration and/or behavioral problems that often occur when a child has problems communicating. Parents should also make sure their child has a hearing screening or test performed since hearing problems may make it appear as though a child has a language or speech problem. If hearing loss or problems are the only cause of delays in speech or language, a hearing aide or medical intervention for hearing may be all that is needed to correct the delay.

Learning disabilities are a group of neurological disorders that become evident in childhood and are characterized by difficulty learning, sorting, and storing information. Children with learning disabilities may have one or more difficulties with skills such as listening, speaking, reading, writing, reasoning, or performing mathematical calculations. These difficulties may interfere with academic performance, achievement, and in some cases, activities of daily living. Often these disabilities are not identified until a child reaches school age.

When a child has a learning disability, performance on standardized tests is usually below that expected for age and schooling. Some children find learning in a regular classroom difficult and special classes may be recommended to help these children receive more specific and intensive teaching. Learning disabilities are lifelong, but proper intervention, training, and strategies can help to maximize a child’s potential.

Intervention and learning strategies for children with learning disabilities include the following:

• Quality instruction: Components of quality instruction specifically for children with a learning disability include:
• • • Explicit or direct instruction (e.g., drill and practice)
    • Strategy instruction (e.g., instruction in the procedure or process used to approach learning)
    • Various teacher behaviors, such as stating the learning objectives, having a clearly organized lesson plan, reviewing concepts multiple times, providing examples, and proceeding through material in small steps.
• Response to intervention services: When children are not succeeding academically, “response to intervention” services often are provided before the child is formally evaluated for a learning disability. The child’s response to intervention can help distinguish learning problems related to inadequate instruction from learning problems related to a learning disability.
• Specific interventions for reading disabilities, math disabilities, and writing disabilities: For example, instruction for children with writing disabilities should incorporate explicit and strategy instruction in handwriting accuracy, handwriting fluency, phonologic awareness and phonics (to help with spelling), language conventions (spelling and grammar), writing text, and composition. Instruction for children with math difficulties should include explicit and strategy instruction in number sense, counting strategy, math vocabulary, arithmetic combination and calculation skills, word problems, visual-spatial relationships, and organizing and planning. Explicit instruction refers to instruction that is focused on the child gaining basic academic skills, largely by repetition and memorization. Strategy instruction refers to instruction in a process that the child can use to approach learning systematically.
• Transition after high school: Planning for the transition to postsecondary school or employment is an important component of managing a learning disability during high school.

• Richardson SO. The child with “delayed speech”. Contemp Pediatr 1992; 9:55.
• Owens RE, Metz DE, Haas A. Introduction to Communication Disorders, Allyn and Bacon, Needham Heights, MA 2000.
• C.M.T. Robertson, N.N. Finer, M.G.A. Grace. School performance of survivors of neonatal encephalopathy associated with birth asphyxia at term. The Journal of Pediatrics. 1989; 114(5) 753-760.
• Kerstjens JM, Bocca-Tjeertes IF, deWinter AF, Reijneveld SA, Boss AF. Neonatal Morbidities and Developmental delay in Moderately Preterm-Born Children. Pediatrics. 2012; 130(2) 265-272.
• Pin TW, Eldridge B, Galea MP. A review of developmental outcomes of term infants with post-asphyxia neonatal encephalopathy. European journal of paediatric neurology. 2009; 13(3) 224-234.
• Harris JC. The classification of intellectual disability. In: Intellectual disability: Understanding its development, causes, classification, evaluation, and treatment, Oxford University Press, New York 2006. p.42.
• McDonald L, Rennie A, Tolmie J, et al. Investigation of global developmental delay. Arch Dis Child 2006; 91:701.
• American Psychiatric Association. Language disorder. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition,
• American Psychiatric Association, Arlington, VA 2013. p.42.